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Wednesday, February 25, 2009

There are many qua|ities that make a good doctor, but you shouldalso remember to overrate experience.

What makes a good doctor

There are many qua|ities that make a good doctor, but you shouldalso remember to overrate experience.

By Dr ALBERT LIM KOK HOOI

A PROFESSOR of mine back in medical school, not otherwise distinguished for academic excellence or linguistic style, was credited with one wisecrack. That was his only claim to fame and glory. He denigrated a hoary colleague of his by saying, "That doctor has 40 years of experience. He has the same one year's experience repeated 40 times."

I think he has something there. Patients do overrate experience in a doctor. Of course experience counts for something. But it is far from everything. It is not even near the top ofthe attributes of a doctor I look for. Certainly not when it is an unthinking experience thatis more of a slog and a plod than anything else.

When is experience important? It takes an experienced doctor to get a patient and his carets to come on board the team. It is pointless to prescribe an effective treatment when the patient is reluctant and resentful about taking it.

In a case where textbooks and journals are not helpful or available, the doctor will bringhis experience to bear. I suppose good bedside manners are honed by years of experience. Asurgeon will need to perform a particular operation several times before he is adept andskilful at it. He climbs the "learning curve".

Surgery is of course much more than cutting and sewing. Two of my gurus, Bernard Fisher and Umberto Veronesi, are surgeons. They went far beyond operating on patients with breast cancer. They thought long and hard about the natural history of breast cancer.

Bernie is alive and well. He still lends his wisdom and advice to the current crop of breast oncologists. Umberto has passed on. We acknowledge the pioneering work he did on breast conserving surgery. We, who treat breast cancer, owe a debt of gratitude to these two.

Experience should be varied. Experience should leave us thinking. Experience should make us learn. However much experience a doctor may have, it is still limited to the minutes and hours of his practice and what his brain makes of it. That is so little and confining!

More important than an individual's experience is the pooled documented experience. Notes (well kept I hope) written by tens and hundreds of thousands of doctors are collected, collated and analysed. Articles are written about this invaluable collective experience and duly published.

Experience should be combined with wisdom, judgement and knowledge. Wisdom is something we have lost in our overloaded world of information.

I can tell you what wisdom is not. It is not information, it is not knowledge, it is not skills and it is certainly not experience. It is not measurable. I leave it to you in your infinite wisdom (ah-hem) to decide what wisdom is.

Judgement is equally difficult to calibrate.We also know it by its absence. Think of Bush,Cheney and Rumsfeld. Think of the judgements handed down by the law courts. Think of a drunk driver. Wisdom and judgement are to be quietly reflected upon rather than shrieked about in a sanctimonious manner.

Knowledge is an easier customer. Medical knowledge and scientific knowledge are indispensable to a doctor. The more journals he reads, the less likely he is to shortchange a patient by giving outdated treatment.

The more seminars and conferences he attends, the more he learns of what his "cutting edge" colleagues are thinking about and doing. In many countries, doctors are tested every year on their knowledge and skills before their license to practise is renewed.

I will go one step further when speaking of a doctor's knowledge, skills and expertise. In my opinion every doctor must be well versed with statistics and mathematics. How else can he make sense of the articles in contemporary medical journals strewnwith hazard ratios, pvalues and confidence intervals?

Barack Obama was not elected because of his experience. The American people decided he had the wisdom and good judgement to lead them andthe world.

Alexander the Great conquered almost all of what was known of the western world in his early 30s.

Two thousand years ago, a wise, holy, politically-savvy man persuaded and preached andpontificated. His influence on Western art, music and literature reverberates till today.

And he did all that ~in his twenties and early thirties.

Emily Dickenson wrote beautiful and moving poems. She was a recluse in Amherst, Massachusettes, with a fertile imagination.

Shakespeare himself did not travel that much in Europe and Italy. His plays set in Italy(The Merchant of Venice, Julius Caesar, Romeo and Juliet, The Two Gentlemen of Verona, etc)would make us think he lived and experienced the Italian way of life for decades.

The good doctor is well-mafinered, experienced, wise, creative, of good judgement and most of all, knowledgeable, scientific and mathematical.

Met any lately?

Dr Albert Lira Kok Hooi is a consultant oncologist. For further information, e-mail star-health@thestar.com.my. The views expressed are those of the writer and readers are advised to always consult expert advice before undertaking any changes to their lifestyles. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

Sunday, August 10, 2008

Doctor in the air

Doctor in the airIs there a doctor on board? If you're feeling ill, recovering from an operation or pregnant, think before you fly.

Boarding a giant metal structure that flies can seem precarious at the best of times. But to need urgent medical attention suddenly at 35,000ft above the ground can be a terrifying experience.

Just ask Nicola Delemere, 31, from Scunthorpe. Her waters broke on a plane en route to Crete from Manchester in April.

With the help of air stewardess Carol Miller, Aide was born three months prematurely,weighing only lib loz, while the plane was over Dusseldorf. His breathing was so poorthat the quick-thinking Miller had to use a drinking straw to inflate his lungs and thenperform mouth-to-mouth and heart massage until the diverted plane landed at Gatwick(the Delemeres did not want any publicity about their son's birth until doctors consid-ered his condition safe).

Little Aifie's mid-air drama had a happy ending. There was a less pleasant experiencefor Paul Trinder, a businessman who had paid pounds 4,000 to travel first class with BAfrom London to Delhi.

He woke up mid-flight to find a corpse sitting near him. The woman in her 70s had died after takeoff and crew had stowed the body in a seat.in order to give the grieving family some privacy.

"Medical incidents on aeroplanes are pretty common," says Dr Richard Dawood, who specialises in travel medicine. "I have been called upon on planes countless times, though luckily for nothing too serious."

Airlines say they do not publish specific numbers of medical incidents on board because the term covers everything from a dizzy spell to a heart attack. British Airwaysestimates that it has between 40 and 50 serious emergencies that require a plane to bediverted each yeau

"It's very rare for a complaint to be so serious that the plane has to be diverted." saysDr Dawood. "And the provisions for medical emergencies are a lot better than they werea few years ago. Defibrillators have only become the norm in the last decade."

Many airlines have started to use technology that allows them to speak to"telemedical"centres on the ground. The biggest of these is MedLink, which is based in Arizona and used by nearly 80 airlines.

Their support staff can converse in 140 languages and are able to give expert medicaladvice, as well as identify the nearest airports with hospitals close by.

But the level of medical apparatus on board varies from carrier to carrier. 'q'here is obviously going to be more equipment on a longhaul than a short-haul flight," says Dawood. "and you will probably be better cared for travelling on a premium airline than a budget oue."

Yet recently there have been disturbing cases that raise many questions. In September last year, a 25-year-old Italian woman died on a Ryanair flight from Venice after suffering a blood clot on the lungs: a doctor who tried to treat her claimed that there wasn't basic medical equipment on board (Ryanair say they are now reviewing their procedures).

And in 1995 one British doctor on a longhaul flight from Hong Kong had to operate on a woman with a collapsed lung with just a coat hanger, a water bottle and some Sellotape.

There is no law determining how much medical equipment a plane should carry, butDr Dawood says that airlines carry apparatus "because it's considered good practice, andbecause nobodywants to be sued".

All cabin crew are now gwen basic first-aid instruction, with some airlines upping thestakes considerably - for example, all Singapore Airlines' crew have been trained to deliver babies.

For those who are concerned about flying with medical conditions, a British Airwaysspokesman says that "the phrase 'prevention is better than cure' applies".

The World Health Organisation recommends that you avoid flying if you have an ear, nose or sinus infection, or heart and lung conditions.

"Talk to your doctor if you have just had an operation, especially if it involved diagnostic use of gas as the cabin air pressure can cause it to expand. Anothercondition to watch out for is anaemia, as the decreased amount of oxygen in planes can cause hypoxia (a shortage of oxygen in the blood).

'As for pregnant women, they should avoid flying after their 36th week. or 32nd if they are expecting twins."

Otherwise it's best to sit back. relax, enjoy your flight.., and be reassured: if you're on alarge commercial plane, Dr Dawood says that there is a high statistical chance of there being a doctor on board.

In fact, reflect on the luck of one Ryanair passenger who required treatment during a flight to Dublin. When crew appealed for help, 15 hands were raised. It turned out that a large group on board were doctors going on a golfing break and one of them. Dr PunitRamrakha, even happened to be Tony Blair's heart specialist.